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TOWN OF HUDSON, NEW HAMPSHIRE RESIDENTIAL SEWER CONNECTION (Town of Hudson)

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File type: PDF

U.S.A. forms for Town of Hudson

BROWSE TOWN OF HUDSON (NH) FORMS

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TOWN OF HUDSON, NEW HAMPSHIRE
RESIDENTIAL SEWER CONNECTION APPLICATION
NOTE: THIS FORM WILL NOT BE ACCEPTED UNTIL SECTION 1 HAS BEEN
COMPLETED AND APPLICATION FEES HAVE BEEN SUBMITTED.
1. OWNER INFORMATION
NAME: ___________________________________________________________
ADDRESS: ___________________________________________________________
TELEPHONE: _______________________________ EXT: ______________________
BUILDING LOCATION: __________________________________________________
TAX MAP: _____________ LOT: ______________________
PUMP SYSTEM YES ______ NO ________
TYPE OF BUILDING:
a) __________ SINGLE FAMILY DETACHED RESIDENTIAL STRUCTURE
b) __________ SINGLE FAMILY WITH IN-LAW APARTMENT
c) __________ DETACHED CONDEX
d) __________ MANUFACTURED MOBILE HOME
e) __________ DUPLEX RESIDENTIAL STRUCTURE # OF UNITS _______
f) ATTACHED RESIDENTIAL UNITS WITH MORE THAN TWO UNITS:
__________ TOWN HOUSE # OF UNITS __________
__________ GARDEN APARTMENT # OF UNITS __________
STATUS OF SEWER CONNECTION:
NEW CONNECTION REPAIR/REPLACEMENT
By applying for this connection, I agree to abide by all applicable Town, State and Federal
requirements.
SIGNATURE: __________________________________________________________
OWNER (If different from above, include address and telephone number:)
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2. FEE PAYMENT
$50.00 PROCESSING FEE PAID:
DATE: __________ RECEIPT NO.# __________ RECEIVED BY: __________
3. SEWER FOREMAN REVIEW (ATTACH COMMENTS)
____________ Street opening permit required (Check if applicable)
Special conditions: CLEAN OUT AT PROPERTY LINE, 24 HOUR
NOTICE PRIOR TO EXCAVATION - 886-6018
______________________________________________________________________
______________________________________________________________________
_________________________________________ ______________________
Sewer Foreman Date
4. TOWN ENGINEER REVIEW (Circle if applicable or not applicable)
a) a. single-family detached residential structure $2,325.00
b) single family with in-law apartment $3,100.00
c) detached condex 1,940.00
d) mobile home 1,550.00
e) duplex residential structure (per unit) 1,705.00
f) attached residential units with more than two dwelling units:
townhouse (per unit) 1,550.00
garden apartment (per unit) 1,160.00
Approved _________ Disapproved __________
Special conditions: ______________________________________________________
_______________________________________ _________________________
Town Engineer Date
5 DATE SEWER CAPITAL ASSESSMENT PAID: __________________________
RECEIPT NO#. ____________________ RECEIVED BY:____________________
6. PAYMENT AGREEMENT: ___________ YES __________ NO
APPROVED __________ DISAPPROVED __________
______________________________________ ___________________
Finance Director (approval of agreement) Date
7. SEWER CONNECTION CERTIFICATION
Date of connection: _______________________________________
Inspected by: _______________________________________
Signature: _______________________________________
Date: _______________________________________
Building Location: _______________________________________
Tax Map: ____________________ Lot: ____________________
Revised 2/26/14
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TOWN OF HUDSON, NEW HAMPSHIRE RESIDENTIAL SEWER CONNECTION (Town of Hudson)

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Completed 18 February 2021

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